Nearly one million who died of Covid-19 also illuminated treatment

The nearly 1 million people around the world who have lost their lives to Covid-19 have left us a gift: Through desperate efforts to save their lives, scientists now better understand how to treat and prevent the disease — and millions of others may survive.

Ming Wang, 71, and his wife were on a cruise from Australia, taking a break after decades of running the family's Chinese restaurant in Papillion, Nebraska, when he was infected. In the 74 days, he was hospitalised before his death in June, doctors frantically tried various experimental approaches, including enrolling him in a study of an antiviral drug that ultimately showed promise.

“It was just touch and go. Everything they wanted to try we said yes, do it,” said Wang's daughter, Anne Peterson. “We would give anything to have him back, but if what we and he went through would help future patients, that's what we want.” Patients are already benefiting.

Though more deaths are expected this fall because of the recent surge in coronavirus infections in the U.S. and elsewhere, there also are signs that death rates are declining and that people who get the virus now are faring better than did those in the early months of the pandemic.

“Some of the reason we're doing better is because of the advances," Dr Francis Collins, director of the U.S. National Institutes of Health, told The Associated Press. Several drugs have proved useful and doctors know more about how to care for the sickest patients in hospitals, he said.

We're in the “stormy adolescence” phase of learning what treatments work — beyond infancy but not “all grown up either,” Collins said.

The nearly 1 million deaths attributed to the coronavirus in nine months are far more than the 690,000 from AIDS or the 400,000 from malaria in all of 2019. They're trending just behind the 1.5 million from tuberculosis.

Wealth and power have not shielded rich countries from the awful power of the virus. The United States “has been the worst-hit country in the world” with more than 6 million coronavirus infections and more than 200,000 deaths, reflecting “the lack of success that we have had in containing this outbreak,” Dr Anthony Fauci, the nation's top infectious disease specialist, told a Harvard Medical School audience earlier this month.

More than 40 per cent of U.S. adults are at risk for severe disease from the virus because of high blood pressure and other conditions. It's not just old people in nursing homes who are dying, Fauci stressed.

Dr. Jesse Goodman, a former US Food and Drug Administration chief scientist now at Georgetown University, agreed.

“Nobody should make a mistake about this” and think they're not at risk just because they may not personally know someone who has died or haven't witnessed what the virus can do firsthand, he said.

OPTIMISTIC SIGNS

Although cases are rising, death rates seem to be falling, said Dr. Cyrus Shahpar, a former U.S. Centers for Disease Control and Prevention scientist now at the nonprofit group Resolve to Save Lives.

The virus's true lethality — the infection fatality rate — isn't yet known, because scientists don't know how many people have had it without showing symptoms. What's often reported are case fatality rates — the portion of people who have tested positive and then gone on to die. Comparing these from country to country is problematic because of differences in testing and vulnerable populations. Tracking these within a country over time also carries that risk, but it can suggest some trends.

“The U.S. cumulative case fatality rate in April was around 5 per cent. Now we're around 3 per cent,” Shahpar said.

In England, researchers reported that case fatality rates have fallen substantially since peaking in April. The rate in August was around 1.5 per cent versus more than 6 per cent six weeks earlier.

One reason is changing demographics: More cases these days are in younger people who are less likely to die from their infection than older people are.

Increased testing also is playing a role: As more people with mild or no symptoms are detected, it expands the number of known infections and shrinks the proportion that prove fatal, Shahpar said.

BETTER TREATMENTS

It's clear that treatments also are affecting survival, many doctors said. People who have died from Covid-19, especially ones who took part in studies, have helped reveal what drugs do or do not help.

Dexamethasone and similar steroids now are known to improve survival when used in hospitalised patients who need extra oxygen, but might be harmful for less sick patients.

An antiviral drug, remdesivir, can speed recovery for severely ill patients, shaving four days off the average hospital stay. Two anti-inflammatory drugs, one used in combination with remdesivir — the drug Wang helped test — also have been reported to help although results of those studies have not yet been published.

The jury is still out on convalescent plasma, which involves using antibody-rich blood from survivors to treat others. No large, high-quality studies have tested this well enough to know if it works.